Organization
NORTHWEST SUBURBAN IMAGING ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJAY MEHTA M.D. (PRESIDENT)
(847) 742-9800
Entity
Organization
Contact information
Practice address
1425 N RANDALL RD, ELGIN, IL 60123-2300
(847) 742-9800
Mailing address
34659 EAGLE WAY, CHICAGO, IL 60678-1346
(630) 874-2542
(630) 874-2642
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
036062431
IL
2085N0904X
Nuclear Radiology Physician
036062431
IL
2085R0202X
Diagnostic Radiology Physician
036062431
IL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036062431
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532088
BLUE CROSS BLUE SHIELD
IL
01
—
CK5174
RAILROAD MEDICARE
IL
Enumeration date
03/15/2006
Last updated
06/01/2012
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